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. 2018 Jan 17;18(1):44.
doi: 10.1186/s12879-018-2944-9.

Antimicrobial resistance of Neisseria gonorrhoeae in Germany: low levels of cephalosporin resistance, but high azithromycin resistance

Susanne Buder  1 , Sandra Dudareva  2   3 , Klaus Jansen  4 , Anna Loenenbach  4 , Sergejs Nikisins  4   5   6 , Andrea Sailer  4 , Eva Guhl  7 , Peter K Kohl  7 , Viviane Bremer  4 ; GORENET study group
Collaborators, Affiliations

Antimicrobial resistance of Neisseria gonorrhoeae in Germany: low levels of cephalosporin resistance, but high azithromycin resistance

Susanne Buder et al. BMC Infect Dis. .

Abstract

Background: The widespread antimicrobial resistance of Neisseria gonorrhoeae is a serious problem for the treatment and control of gonorrhoea. Many of the previously effective therapeutic agents are no longer viable. Because N. gonorrhoeae infections are not reportable in Germany, only limited data on disease epidemiology and antimicrobial susceptibility patterns are available. The Gonococcal Resistance Network (GORENET) is a surveillance project to monitor trends in the antimicrobial susceptibility of N. gonorrhoeae in Germany in order to guide treatment algorithms and target future prevention strategies.

Methods: Between April 2014 and December 2015, data on patient-related information were collected from laboratories nationwide, and susceptibility testing was performed on 537 N. gonorrhoeae isolates forwarded from the network laboratories to the Conciliar Laboratory for gonococci. Susceptibility results for cefixime, ceftriaxone, azithromycin, ciprofloxacin and penicillin were defined according to EUCAST 4.0 standards. Percentages, medians and interquartile ranges (IQR) were calculated.

Results: Altogether, 90% of isolates were from men. The median age was 32 (IQR 25-44) years for men and 25 (IQR 22-40) years for women (p-value < 0.001). The most frequently tested materials among men were urethral (96.1%) and rectal swabs (1.7%), and among women, it was mainly endocervical and vaginal swabs (84.3%). None of the isolates were resistant to ceftriaxone. Furthermore, 1.9% (in 2014) and 1.4% (in 2015) of the isolates were resistant to cefixime, 11.9% and 9.8% showed resistance against azithromycin, 72.0% and 58.3% were resistant to ciprofloxacin, and 29.1% and 18.8% were resistant to penicillin.

Conclusions: Resistance to ceftriaxone was not detected, and the percentage of isolates with resistance to cefixime was low, whereas azithromycin resistance showed high levels during the observation period. The rates of ciprofloxacin resistance and penicillin resistance were very high across Germany. Continued surveillance of antimicrobial drug susceptibilities for N. gonorrhoeae remains highly important to ensure efficient disease management.

Keywords: Antimicrobial resistance; Gonorrhoea; Neisseria gonorrhoeae; Resistance surveillance.

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Conflict of interest statement

Ethics approval and consent to participate

The data-collection protocol was confirmed by the data-protection officer. Additional approval from an ethics committee was deemed not necessary, as no patient-identifying data were collected. According to the German Data Protection Act the study complies with the national guidelines, and no formal ethical committee approval was necessary (available under https://www.gesetze-im-internet.de/bdsg_1990/index.html)

Consent for publication

Not applicable

Competing interests

Klaus Jansen is a member of the editorial board (Associate Editor) of this journal. All other authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Distribution of N. gonorrhoeae samples by district in Germany. One thousand, six hundred and fifty-four samples from April 2014 to December 2015 (1366 defined by district code of the patient, 288 defined by district code of the laboratory). Map developed with RegioGraph Software
Fig. 2
Fig. 2
N. gonorrhoeae samples tested in participating laboratories, by age group and gender, n = 1642
Fig. 3
Fig. 3
Distribution of minimum inhibitory concentrations for ceftriaxone, n = 261 for year 2014 and n = 276 for year 2015
Fig. 4
Fig. 4
Distribution of minimum inhibitory concentration for cefixime, n = 261 for year 2014 and n = 276 for year 2015
Fig. 5
Fig. 5
Distribution of minimum inhibitory concentration for azithromycin, n = 261 for year 2014 and n = 276 for year 2015
See this image and copyright information in PMC

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